Functional Outcomes of Intramuscular Botulinum Toxin Type A and Occupational Therapy in the Upper Limbs of Children With Cerebral Palsy: A Randomized Controlled Trial
Presented in part to the OT Australia 22nd National Conference, April 6–9, 2003, Melbourne, Australia, and the Australasian Academy of Cerebral Palsy and Developmental Medicine, March 19–20, 2004, Melbourne, Australia.
Abstract
Wallen M, O’Flaherty SJ, Waugh MC. Functional outcomes of intramuscular botulinum toxin type A and occupational therapy in the upper limbs of children with cerebral palsy: a randomized controlled trial.
Objective
To investigate the functional outcomes of botulinum toxin type A (BTX-A) injections to the upper limb in combination with occupational therapy (OT) in children with cerebral palsy (CP).
Design
Randomized controlled trial with follow-up at 2 weeks, 3 months, and 6 months.
Setting
Specialist outpatient physical disabilities clinic within a public pediatric teaching hospital.
Participants
Eighty children with spastic quadriplegic, triplegic, or hemiplegic CP from these clinics were randomly assigned to BTX-A plus OT, BTX-A alone, OT alone, or a no-treatment control group.
Interventions
Single set of BTX-A (Botox) injections and 12 weeks of OT.
Main Outcome Measures
Canadian Occupational Performance Measure (COPM) and Goal Attainment Scale (GAS).
Results
The combination of BTX-A and OT resulted in accelerated attainment of functional goals measured by the COPM and GAS. There were no differences between groups on the Melbourne Assessment of Unilateral Upper Limb Function, Quality of Upper Extremity Skills Test, Pediatric Evaluation of Disability Inventory, Child Health Questionnaire, or active and passive range of motion. As expected, there was a significant reduction in muscle tone at follow-up 2 weeks after injection, which returned to baseline level by 6 months.
Conclusions
OT enhanced individualized functional outcomes following BTX-A injections in the upper limbs of children with CP.
aDepartment of Occupational Therapy, The Children’s Hospital at Westmead, Sydney, Australia
bDepartment of Rehabilitation, The Children’s Hospital at Westmead, Sydney, Australia.
Correspondence to Margaret Wallen, MA, BAppScOT, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead NSW 2145, Australia
Supported by The Children’s Hospital Fund of The Children’s Hospital at Westmead and Allergan Australia.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.
ABSTRACT